Sample Utilization Review Nurse Resume

Posted in Nurse Resume Samples

Sabrina Thomas
1637 Lady Bug Drive
Colorado Springs, CO 80903

Career Objective To obtain a position as an Utilization Review Nurse where my special skills can be used to their fullest potential to help improve the hospital.

Summary of Qualifications:

  • Remarkable experience in geriatric nursing, renal, cardiac and endocrinology
  • Exceptional knowledge of utilization review, case management, and disease management
  • Solid understanding of state and federal regulatory requirements affecting care coordination services, specifically CMS, Medicaid and HIPAA
  • Proficient in Microsoft Word, Excel and utilization review modules in information systems
  • Ability to work as a team member to strategize future program enhancements
  • Ability to provide commitment to excellence in nursing and to communicate well with frail elderly and providers

Work Experience:

Utilization Review Nurse, August 2005 – Present
Coventry Health Care, Colorado Springs, CO

  • Managed assigned workload within established performance standards.
  • Participated in discharge planning process with hospital and inpatient facility staff, ensuring adequate and appropriate disposition and post discharge plans.
  • Coordinated smooth transition and follow-ups from one level of care and service to another.
  • Maintained all required documentation in the information systems.
  • Participated in case conferences, clinical in-services, and other educational opportunities.
  • Recorded information in Claims Management system and communicated with the Claims Adjuster to process valid medical treatment requests for authorization per policy.

Utilization Review Nurse, May 2000 – July 2005
XLHealth, Colorado Springs, CO

  • Determined medical necessity of the requested treatment.
  • Communicated with requesting providers, service providers, claims adjusters and claimants via telephone and fax to request additional information.
  • Coordinated care and provided verbal authorization for medical treatment per policy.
  • Assisted in medical training for claims adjusters.
  • Maintained ongoing compliance with federal, state or Federal laws, URAC standards.
  • Ensured cost effective and quality patient care by appropriate utilization of medical resources.


B.S in Health Services Management, Florida State University, Tallahassee, FL

Example #2

Kelsey Lee
602 S Main St
Oak Park, CA 91301
[email protected]

Objective Looking for a challenging role as an Utilization Review Nurse in the field of the nursing and caring where my skills and knowledge can be utilized effectively.

Career Profile:

  • Immense ability to work under stress, both with and without supervision.
  • Strong ability to quickly analyze and interpret data.
  • Extensive working experience in the field of case management and utilization review.
  • Sound knowledge in conducting and reviewing medical record for medical necessity.
  • Wide knowledge of health care service delivery schemes and third party reimbursement.

Nursing Experience:

Utilization Review Nurse, 2004 to till date
UCLA Medical Center, Los Angeles, CA

  • Maintained records of the utilization review department.
  • Monitored and reported on patient activities, mental status and progress to the insurance company.
  • Performed utilization review in accordance with all state mandated regulations.
  • Reviewed patient’s records and evaluated patient’s progress.
  • Aided and coordinated telephonic and on-site inpatient and outpatient care through precertification, concurrent review and discharge planning.

Academic Background

Health Care Quality & Management Board Certification, 2004
Yale School of Nursing, New Haven, CT

B.S in Nursing, 2003
University of Washington, Seattle, WA

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